Smoking linked to higher risk of tooth loss in postmenopausal women

Women might be better at regular brushing, flossing and having regular dental exams, but if they are long-time heavy smokers, they still have a high risk of tooth loss due to periodontal disease, according to a new study.

To unravel some of the causes behind tooth loss in postmenopausal women who smoked, researchers at the University of Buffalo examined the comprehensive smoking histories of about 1,100 postmenopausal women who participated in the Buffalo OsteoPerio Study (part of the Women's Health Initiative, the largest clinical trial and observational study in the U.S. that involved more than 162,000 women nationwide).

"Regardless of having better oral health practices, such as brushing and flossing, and visiting the dentist more frequently, postmenopausal women in general tend to experience more tooth loss than men of the same age," says Xiaodan Mai, a doctoral student in epidemiology in the UB Department of Social and Preventive Medicine in the School of Public Health and Health Professions and one of the study's authors. "We were interested in smoking as a variable that might be important."

Heavy smokers studied—those who had at least 26 pack-years of smoking, or the equivalent of having smoked a pack a day for 26 years—were nearly twice as likely to report having experienced tooth loss overall and more than six times as likely to have experienced tooth loss due to periodontal disease, compared to those who never smoked.

Participants answered a detailed questionnaire about their smoking history. Each participant also underwent a comprehensive oral examination and reported to the dental examiners reasons for each tooth lost. In some cases, the patient’s dental records also were reviewed.

"We found that heavy smokers had significantly higher odds of experiencing tooth loss due to periodontal disease than those who never smoked," said Ms. Mai. "We also found that the more women smoked, the more likely they experienced tooth loss as a result of periodontal disease."

On the other hand, they found that smoking was a less important factor in tooth loss due to caries. That’s an important distinction, she added. "Periodontal disease is a chronic, inflammatory condition that may be related to the development of cancer," she explains.

The study, which appears in the March 2013 issue of The Journal of the American Dental Association, notes that cigarette smoke may accelerate periodontal disease and that other studies suggest that chemicals found in smoke may favor plaque-forming bacteria that could reduce the ability of saliva to be antioxidative. Nicotine also has been shown to reduce bone density and bone mineral factors while estrogen hormones have been found to be lower among women who smoke.

Ms. Mai is now interested in pursuing research that could determine whether smokers with periodontal disease are at even greater risk for certain cancers than smokers without periodontal disease.

"Tooth loss due to periodontal disease is a prevalent condition among postmenopausal women that severely impacts their dietary intake, aesthetics and overall quality of life," said Ms. Mai. "Women now have yet another, very tangible reason for quitting smoking."